2009-04-17_REPORT - M1999047

• Permit No: M1999047
• IBM Index Class Name: REPORT
• Doc Date: 4/17/2009
• Doc Name: Annual Fee/Report/Map
• From: Adamson Brothers & Sons Feedlot, Inc.
• To: DRMS
• Permit Index Doc Type: Annual Fee/Report
• Media Type: D
• Archive: No

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PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
7-
A 'E-
ANNUAL FEE and REP RT REOUEST
0/?Adamson Brothers & Sons Feedlot, Inc.
11,M-1999-047
Adamson Bros. Mine
May 10, 2009
e`)
APR 17 2009
Division ota d Safety n
Mi,??9
$$323.00 (Due on or before your anniversary date)
Yuma
According to C.R.S. 34-32.5-116 or C.R.S. 34-32-116, each year, on the anniversary date of the permit, an
operator shall submit the annual- Tee,, A report an`d-"map` showing the extent`of curren disturbances to of eced- -
land, reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to
occur during the upcoming year, reclamation that will be performed during the coming year, the dates for the
beginning of active operations, and the date active operations ceased for the year, if any.
Please attach your revised written annual report and annual report map to this form. The Annual
Report & Fee requirement is not met until we have received the following components: fee, report, and
associated map. If no new disturbances or reclamation have occurred during the previous year and no
new changes to the previous year's map are necessary, then no new map is required, provided that the
Operator shall state this in the Annual Report. Please note that an adequately labeled map that clearly
delineates and includes the above elements may suffice for a written report.
Division records indicate the following permittee contact information. Please verify and make any necessary
changes:
Permittee Contact: Mike Adamson
Permittee Name: Adamson Brothers & Sons Feedlot, Inc.
Address:
Phone Number:
Fax Number:
CO Rd RR 34360
P.O. Box 321
Wray, CO 80758
[phone]
c-70 -332 3IZ-7:?,
If you have additional comments and/or information that should be provided to the Division, please provide it
below or attach it to this form along with your written report and map. Annual Report instructions are
enclosed.
gnature o orporate Of icer, Owner, or Designee
?(I /6 /Cc?
Date
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